Tissue holding power to a single suture in different parts of the alimentary tract.

Figures for tissue strength are reported from an investigation on the tissue holding power to a single suture in 8 parts of the gut between oesophagus and rectum in 71 preparations from 44 individuals. 1749 experiments were done. Three layers were tested in each part of the gut. The mean holding power of sutures in the mucosa was 0.26-0.83 kp, for those in the seromuscular coat 1.03-2.24 kp, and for through-and-through sutures, 1.02-2.54 kp. Appreciable differences in tissue strength appear to exist between different parts of the alimentary tract. The lowest values were noted in the oesophagus and sigmoid, and the highest in the stomach and colon. Sutures through the whole gut wall were hardly any stronger than sutures in the sero-muscular coat. There was a significant difference in holding power in cancer compared with non-cancer cases. The holding power was considerably reduced in subjects with cancer in the alimentary tract. Knowledge of tissue strength in the gut may help to explain why anastomoses break down, and will provide a firmer basis for the choice of sufficiently strong suture material and knots with a view to preventing this complication.